Type 1 diabetes Flashcards
what is type 1 diabetes?
a state of absolute deficiency
how is T1DM diagnosed?
fasting glucose >/= 7
random >/= 11.1
symptoms
GAD/IA2 antibodies
which gene is associated to 50% of familial risk of T1DM?
HLA
what triggers have been associated with T1DM?
viral infections
maternal factors
weight gain
what are the 4 isle auto-antibodies (ICA)?
IA-2
IAA
GAD65
ZnT8
what is the antigen for GAD65b?
glutamic acid decarboxylase
what is the antigen for IA-2Ab
islet antigen 2
what is the antigen for IAA
insulin
what is the antigen for ZnT8Ab
ZnT8 transporter
what is the function of Glutamic acid decarboxylase?
GABA production
does glutamic acid decarboxylase increase or decrease with age?
increases with age
which sex is glutamic acid decarboxylase associated with?
females less than 10 yrs old
does islet antigen 2 increase or decrease with age?
decreases with age
what is the function of insulin?
regulates glucose
in which age group does insulin function better?
in children
what is the function of ZnT8 transporter?
Zn function in beta cells
in which age group is ZnT8 transporter better in?
the older
what are the foetal risk factors for T1DM?
Maternal factors: infection age ABO mismatch birth order stress
what are the disease makers that can be found in foetal life?
Genetics:
HLA
non-HLA
what are the pre-diabetes risk factors in children?
Auto-immune trigger factors: viral infecton Vit. D deficiency Dietary factors Environmental toxins
what disease markers can be found in pre-diabetic stage in children?
auto-immune process:
autoantibodies esp. GAD 65 & IA2
candidate antigens
insulitis
what are the accelerating factors of T1DM?
infection insulin resistance puberty diet/weight stress
what are the disease markers/features of clinical T1DM?
raised glucose
ketones
decreased insulin
decreased beta cell mass decreased C-peptide
what is the classic triad of presenting symptoms?
polyuria (enuresis in children)
polydipsia
weight loss
what presenting symptoms aside from the classic triad are common?
fatigue & somnolence
blurred vision
candidal infection
in established keto-acidosis
which 2 candidal infections are commonly presented with T1DM?
pruritis vulvae
balanitis
what is the first step of management in T1DM?
blood glucose & ketone monitoring insulin carbohydrate estimation regular DSN & dietitian contact medical clinic review regular check of glycemic control annual review assessment
what type of insulin regimen is initially employed for T1DM?
basal (once daily) bolus with meal
what can be used to check prevailing glycemic control?
HbA1c
what is assessed in the annual review assessment?
weight blood pressure bloods: HbA1c, renal function & lipids retinal screening foot risk assessment
into which vein is insulin normally secreted?
the portal vein
what rate is insulin secreted at in fasted state?
0.25-1.5 units of insulin per hour
if a child is diagnosed with diabetes under the age of 6 months, is it likely to be T1DM?
no, more likely to have monogenic diabetes
what is LADA?
latent onset diabetes of adulthood
how is a diagnosis of LADA established?
by the presence of elevated levels of pancreatic auto-antiboodies in patients with recently diagnosed diabetes who do not initially require insulin
what are the other 2 names for LADA?
slowly progressive Type 1
Type 1.5 diabetes
which other genetic disease is common in diabetes?
cystic fibrosis
what are the relatively common auto-immune conditions associated with diabetes in general?
thyroid disease coeliac disease pernicious anaemia addison's disease IgA deficiency
what are the rare auto-immune conditions associated with diabetes in general?
auto-immune polyglandular syndromes
AIRE mutations
IPEX syndrome
what are the 4 devices that can be used to administer insulin?
syringe
disposable pen
reusable cartridge pen
continuous subcataneous insulin infusion pump
which of the 4 devices cannot be used for self-administration of insulin?
syringe
in what pattern is insulin normally secreted?
low basal rate continuously & spikes of post-prandial insulin
which insulin regimen aims to mimic normal endogenous insulin production?
basal bolus insulin
what is the first line insulin regimen in T1DM?
basal bolus insulin with patients knowing how to calculate insulin dose in relation to food
how long does an insulin analogue take to start to work?
10-15 mins
when is the peak action of insulin analogues?
60-90 mins
how long id the duration of insulin analogues?
4-5hrs
how long does it take for soluble insulin to start to work?
30-60 mins
when is the peak action of soluble insulin?
2-4hrs
how long is the duration of soluble insulin?
5-8 hrs
what are the 2 types of basal insulins?
isophane “basal” insulins
analogue basal insulins
what are the 2 types of fast acting insulin?
insulin analogues
soluble insulin
what is the action length of isophane “basal” insulins like?
intermediate/long acting
when is the peak action of isophane “basal” insulins?
4-6 hours after administration
whhich of the 2 types of long acting insulin is the longest acting?
analogue basal insulins
what are the components of advanced carbohydrate counting?
insulin to carbohydrate ratio (ICR)
insulin sensitivity factor (ISF)
what is insulin sensitivity factor also known as?
correction factor (CF)
what does an insulin pump administer?
continuous administration of short acting insulin - basal rate
what must a patient using an insulin pump do before meals?
deliver manually activated bolus of insulin
who is metabolic control evaluated?
home blood glucose monitoring
urine testing
glycated haemoglobin (Hb1Ac)
continuous glucose monitor
what is the best way to get a clear picture of metabolic control?
continuous glucose monitor
how is glycated haemoglobin formed?
non-enzymatic glycation of haemoglobin on exposure to gluose
what are the problems with systems currently used to administer insulin?
Insulin injection or pump - into subcutaneous tissue peak too slow to prevent post-meal hyperglycaemic spike - slow clearance
what are the factors affecting insulin absorption/action?
temperature
injection site
injection depth
exercise
when is IV insulin prescribed?
- DKA
- role in hyperosmolar hyperglycaemic state
- acute illness
- fasting patients who are unable to tolerate oral intake
what are the indications for a pancreas transplantation?
Imminent or ESRD due to receive or with kidney transplant
Severe hypoglycemia/ metabolic complications
Incapacitating clinical or emotional problems
who is pancreatic islet transplantation usually reserved for?
for those with:
episodes of severe hypoglycaemia
Severe and progressive long-term complications despite maximal therapy
Uncontrolled diabetes despite maximal treatment
what are the 4 key steps of islet transplantation?
pancreas donation & retrieval
islet isolation
islet culture
islet transplantation
what must be done after an islet transplantation?
close follow up for 4-6 weeks
immunosuppression
